CMS Price Transparency Data

CT scan, sinuses

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $308
Cash Discount Price: $737
vs. Medicare Baseline: 2.88x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Iowa Specialty Hospital - Clarion is $308. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $737. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.88x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$737

Average discount available for prompt cash payment at this facility.

Insurance Median

$308

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $737 (690%)

Insurance Median: $308 (288%)

Cash: $737 (690% of Medicare)

Ins. Median: $308 (288% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 288% of the Medicare baseline (a markup of 188%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Tricare	$38 - $682	36%
Triwest Va - All Plans	$38 - $682	36%
Aetna	$42 - $1,870	39%
Healthscope Stellar-All Plans	$62 - $1,162	58%
Wellmark Hmo	$78 - $329	73%
Wellmark Ppo - All Other Plans	$88 - $362	82%
Health Partners Ish-All Other Plans	$97 - $1,760	91%
UnitedHealthcare	$108 - $2,090	101%
Auxiant Clarion Schools-All Plans	$166 - $1,430	155%
Health Partners Prestage	$191 - $1,650	179%
Cigna	$286 - $2,134	268%
Midlands Choice-All Plans	$286 - $2,134	268%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $737.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70486.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Iowa Specialty Hospital - Clarion is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70486.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.